A national study puts Grundy at the bottom of Tennessee's 95 counties when it comes to factors affecting health and life expectancy, including death rates, access to health care and healthy foods, economic and education factors, diet and smoking rates.

Even at dead last, Grundy is not far below Marion and Sequatchie, which rank 88th and 89th, respectively. Meigs, Rhea and Polk all rank in the bottom 25 percent of Tennessee counties, according to the 2012 County Health Rankings.

The study, released in April by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, analyzes factors within four categories -- health behaviors, clinical care, social and economic factors and physical environment -- each of which contain several measures.

Grundy ranked in the bottom 25 percent -- 72nd or worse -- of Tennessee counties in three of the four categories, the study shows.

It ranked 89th in health factors, which includes a 35th ranking in health behaviors, 92nd in clinical care and 88th in social and economic factors.

But the county notched a 31st rank -- second best next to Bledsoe among Southeast Tennessee's 10 counties -- under physical environment factors thanks to its clean air and access to healthy food, study officials said.

The study shows "that where you live, work and play matters to your health," and "tells community leaders where they're doing well and where there are opportunities for improvement," said Angela Russell, associate researcher with the project at the University of Wisconsin Population Health Institute.

Russell said the "health outcomes" ranking shows the impact of health factors over time while measures under "health factors" show what's happening now.

She said a major factor in Southeast Tennessee health outcomes rankings arises from the premature death rate, which refers to the number of people who die before age 75.

For Grundy, the premature death rate is 13,947 per 100,000 people (adjusted for comparison) while Bradley is lowest in the region at 8,452 per 100,000. Bledsoe follows just behind Bradley at 8,505, and Hamilton falls in line at 8,597. Even though the counties do not have populations of 100,000, the rates reflect a per-100,000 measurement so counties can be compared equally.

"You've got a really high premature death rate in Grundy compared to the rest of the state, and you have a lot more people reporting they feel physically and mentally unhealthy," Russell said.

On the other hand, Grundy shines in other categories compared with state averages.

For health outcomes rankings in the Sequatchie Valley, the rural county that stands out is Bledsoe, according to Russell.

"They rank 35th out of 95 counties" largely because of a lower premature death rate compared with its neighbors, she said.

To the east, Bradley County leads all others in Southeast Tennessee with a health outcome ranking of 18th and health factors ranking of 19th, the study shows.

Marion County ranked 43rd overall in the four health factors categories but had a high premature death rate of 10,817 per 100,000, which helped put the county in the lowest 25 percent of health outcomes rankings.

Beth Delaney, spokeswoman for the Southeast Tennessee Regional office of the state Department of Health, said the study shows that prime issues for Grundy, Marion and Sequatchie counties, as well as many other rural counties, are the social and economic factors that carry considerable weight in the rankings.